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PD as Number 3 Chronic illness can be like another member of the relationship – It demands attention and resources – It can alter communication patterns – It can elicit strong emotions – It interferes with intimacy, interpersonal and sexual – Sometimes it is personified as in “PD has taken everything from us”

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PD as Number 3 Chronic illness can be like another member of the relationship (continued) – Creates uncertainty about the rules of interaction – Is a source of guilt “I should be more patient. S(he) can’t help it “I am not doing enough for him (her). “I am a burden because of my PD”

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Can A Person Be a Burden? Human beings have an innate right to be honored and accepted as they are and for who they are “Burden” is not a quality of the disease – Circumstances like disease, aging, etc. can make daily living more challenging – Circumstances can make providing a safe, nurturing environment challenging for family members

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Can A Person Be a Burden? “Burden” may be a description of difficult interpersonal behaviors Factors that might be related to being “burdensome”: – Depression/anxiety/demoralization – Executive function – Emotional expression – Social Cognition

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Can A Person Be a Burden? No man or woman is a burden; however they can behave in ways that make living with them more burdensome: – Behavioral inertia and inflexibility – Untreated mood disorder leading to irritability and isolation – Emotional blunting and deficits in social cognition

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Emotional Interpretation Emotional comprehension-What is Going on in Other People – Cognitive slowing may make it hard to track conversations and respond appropriately – PD can slow the ability to understand the emotion expressed by others – Folks with PD have most trouble tracking anger

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Social Cognition Higher Cognitive Function Allowing Us to Interact With the World with some agency – Function separate from but in conjunction with executive processes – Individuals with PD may have increasing difficulties inferring mood state of others – May be related to some degree to impairment in Theory of Mind (ToM)

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Impaired Theory of Mind? ToM- ability to understand and predict other’s behavior by attributing independent mental states to them Two components – Affective – Cognitive “Speaking the Language of Parkinson’s” Workshops online and in person have helped improve communication

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Impaired Theory of Mind? 2011 Review by Poletti and colleagues suggests that – ToM is impaired in early PD in the cognitive but not affective component – Affective component of ToM increasingly affected in advanced PD

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Meeting Cognitive Challenges Develop strategies for managing executive and social cognition challenges – Similar to organizational exercises for individuals with ADD – Recognize that this is another aspect of PD not purposeful behavior – Communication/feedback directly and specifically talking about behaviors